Prediabetes is a condition where your blood sugar levels are higher than normal but not high enough to be diagnosed as type 2 diabetes. It affects about 38% of adults in the United States (1). Without treatment, many people with prediabetes will develop type 2 diabetes within a few years.

What Is Prediabetes?

Prediabetes happens when your body doesn’t use insulin properly or doesn’t make enough insulin. This causes sugar to build up in your blood.

Doctors may use different names for prediabetes, including impaired fasting glucose (IFG), impaired glucose tolerance (IGT), or elevated hemoglobin A1c (2).

Symptoms of Prediabetes

Most people with prediabetes don’t have any symptoms. This is why many people don’t know they have it. However, some people may notice certain signs.

Note
Because prediabetes usually has no symptoms, the only way to know if you have it is through blood tests. Don’t wait for symptoms to appear – get screened if you have risk factors.

Acanthosis Nigricans

One possible sign of prediabetes is darkened skin in certain areas of the body. This condition is called acanthosis nigricans. It appears as dark, velvety patches of skin, usually in:

  • The neck
  • Armpits
  • Groin
  • Knuckles

Acanthosis nigricans is often associated with insulin resistance and may indicate increased risk of type 2 diabetes (3).

In children and young adults, 17% of children and 21% of adults were found to have acanthosis nigricans. The more diabetes risk factors present, the higher the chance of having this skin condition (3).

Healthcare providers consider acanthosis nigricans a simple, non-invasive, cost-effective screening tool for early identification of insulin resistance (4).

Other Skin Changes

Some people with prediabetes may also develop small skin growths called skin tags. These often appear in the same areas as acanthosis nigricans (5).

Signs You May Be Progressing to Diabetes

While prediabetes itself usually has no symptoms, you should see your doctor if you experience:

  • Increased thirst
  • Frequent urination, especially at night
  • Increased hunger
  • Fatigue or feeling very tired
  • Blurred vision
  • Slow-healing cuts or sores
  • Frequent infections

These symptoms may indicate that your prediabetes has progressed to type 2 diabetes.

What Causes Insulin Resistance?

Insulin resistance happens when your cells don’t respond properly to insulin. Several factors contribute to this:

Excess body fat: Extra fat, especially around your belly, makes it harder for your body to use insulin properly. Fat cells release hormones that can increase inflammation and insulin resistance (6).

Physical inactivity: When you don’t exercise regularly, your muscles become less sensitive to insulin. Regular physical activity helps your muscles use glucose better.

Diet: Eating too many processed foods, sugary drinks, and refined carbohydrates can contribute to insulin resistance over time.

Inflammation: Chronic inflammation in your body can interfere with insulin signaling and lead to insulin resistance.

Genetics: Your genes play a role in how your body produces and uses insulin. Having family members with diabetes increases your risk.

How Common Is Prediabetes?

Prediabetes is very common. In the United States, more than 1 in 3 adults have prediabetes. Most people don’t know they have it because it usually doesn’t cause symptoms (7).

Among young people, about 18% of adolescents and 24% of young adults have prediabetes (8).

Risk of Developing Type 2 Diabetes

If you have prediabetes, you’re at high risk of developing type 2 diabetes. About 5-10% of people with prediabetes develop diabetes each year (9).

Different types of prediabetes carry different risks. People with both IFG and IGT have the highest risk, about 12 times higher than people with normal blood sugar (10).

Over time, up to 70% of people with prediabetes will eventually develop diabetes if they don’t make changes to prevent it (11).

Diagnosis of Prediabetes

Doctors use blood tests to diagnose prediabetes. There are three main tests they can use.

Fasting Blood Sugar Test

This test measures your blood sugar after you haven’t eaten for at least 8 hours. A level between 100-125 mg/dL indicates prediabetes (12).

Oral Glucose Tolerance Test

For this test, you drink a sugary liquid and have your blood sugar checked 2 hours later. A level between 140-199 mg/dL indicates prediabetes.

Hemoglobin A1c Test

This test shows your average blood sugar over the past 2-3 months. An A1c between 5.7% and 6.4% indicates prediabetes. Some organizations use slightly different cutoffs (13).

Risk Factors for Prediabetes

Several factors increase your risk of developing prediabetes.

Weight and Body Size

Being overweight is a major risk factor. Each 5-point increase in BMI raises prediabetes risk by 19% (14).

Large waist size also increases risk. Men with waists over 40 inches and women with waists over 35 inches have higher risk (15).

Age and Demographics

Risk increases with age. The American Diabetes Association recommends screening starting at age 35 for people who are overweight (1).

Men are more likely to have prediabetes than women. In young people, 22.5% of males have prediabetes compared to 13.4% of females (8).

Race and Ethnicity

Prediabetes affects people of all races and ethnicities, but some groups have higher rates than others. People who are Black, Hispanic/Latino, Native American, Pacific Islander, or Asian American are at increased risk (8).

People with acanthosis nigricans (dark patches of skin) are more likely to be from ethnic minority groups. In one study, 80% of patients were members of ethnic minorities (3).

Family History

Having a parent or sibling with type 2 diabetes more than doubles your risk. The risk is even higher if both parents have diabetes (16).

Sleep Problems

Not getting enough sleep or getting too much sleep increases your risk. People who sleep less than 5 hours or more than 8 hours per night have higher A1c levels (17).

The relationship between sleep and diabetes risk follows a U-shaped pattern. The lowest risk is with 7-8 hours of sleep per night. Both short sleep (less than 7 hours) and long sleep (more than 8 hours) increase diabetes risk (18).

People with obstructive sleep apnea also have higher risk of prediabetes (19).

Health Risks Associated with Prediabetes

Prediabetes isn’t just about diabetes risk. It also increases your risk of other serious health problems.

Heart Disease and Stroke

People with prediabetes have about twice the risk of heart disease and stroke compared to those with normal blood sugar (20).

A more recent analysis found similar results, with prediabetes increasing heart disease risk by 15% and stroke risk by 14% (21).

Prediabetes also increases the risk of heart failure. People with prediabetes have about 10-40% higher risk of developing heart failure, depending on how prediabetes is defined (22).

Kidney Disease

Prediabetes can affect your kidneys even before diabetes develops. People with prediabetes have a 10-12% higher risk of developing chronic kidney disease (23).

Eye Problems

Some people with prediabetes already show early signs of diabetic eye disease. Regular eye exams are important if you have prediabetes (24).

Liver Problems

People with prediabetes are at higher risk for non-alcoholic fatty liver disease (NAFLD). This is when fat builds up in the liver even though you don’t drink much alcohol. NAFLD is closely linked to insulin resistance and metabolic syndrome (25).

Cancer

Prediabetes is linked to a 15% higher risk of cancer overall. The risk is especially high for liver, endometrial, and stomach/colorectal cancers (26).

Prevention of Type 2 Diabetes

The good news is that prediabetes can often be reversed. Many people can prevent or delay type 2 diabetes through lifestyle changes.

Lifestyle Changes

Making healthy lifestyle changes is the most effective way to prevent diabetes. The Diabetes Prevention Program study showed that lifestyle changes reduced diabetes risk by 58% over 3 years (27).

These lifestyle changes include:

  • Losing 5-7% of your body weight if you’re overweight
  • Getting at least 150 minutes of physical activity per week
  • Eating a healthier diet with more fruits, vegetables, and whole grains

A review of many studies found that people who made lifestyle changes had 22-42% lower risk of developing diabetes (28).

Weight Loss

Even modest weight loss helps. Losing 5-10% of your body weight can significantly reduce your diabetes risk. For every 2.2 pounds lost, diabetes risk decreases by 16% (29).

Physical Activity

Regular exercise helps your body use insulin better. Both aerobic exercise (like walking) and resistance training (like lifting weights) are beneficial. Combining both types may be even better (30).

High amounts of moderate-intensity exercise alone can be very effective at improving glucose tolerance (31).

Diet Changes

Several dietary approaches can help prevent diabetes:

Mediterranean Diet: Following a Mediterranean diet (rich in fruits, vegetables, whole grains, and olive oil) is associated with lower diabetes risk (32).

DASH Diet: The DASH (Dietary Approaches to Stop Hypertension) diet improves blood sugar control in people with prediabetes (33).

Low-Carbohydrate Diet: Reducing carbohydrate intake can improve blood sugar control and insulin resistance (34).

Medical Treatments for Prediabetes

While lifestyle changes are the first choice, medications may help some people with prediabetes.

Metformin

Metformin is the most commonly used medication for prediabetes. It reduces diabetes risk by about 31% over 3 years (27).

Metformin works best for:

  • Women with a history of gestational diabetes
  • People younger than 60 years
  • People with BMI of 35 or higher
  • People with fasting glucose of 110 mg/dL or higher

Other Medications

Several other medications have been studied for preventing diabetes:

GLP-1 receptor agonists: These newer medications are very effective, reducing diabetes risk by more than 50% in some studies (35).

Alpha-glucosidase inhibitors: Medications like acarbose reduce diabetes risk by about 18% (36).

Vitamin D

Recent research shows vitamin D supplementation may help prevent diabetes in people with prediabetes. A large analysis found vitamin D reduced diabetes risk by about 15% (37).

Natural Supplements

Some natural products may help with blood sugar control:

Cinnamon: Studies show cinnamon can lower fasting blood sugar, though effects on A1c are less clear (38).

Zinc: Zinc supplementation may help improve blood sugar control and reduce progression to diabetes (39).

Alternative and Complementary Approaches

While lifestyle changes and medications are the main treatments for prediabetes, some people also use complementary approaches.

Mind-Body Practices

Stress management is important because stress can affect blood sugar levels. Techniques that may help include:

  • Meditation
  • Yoga
  • Deep breathing exercises
  • Regular relaxation practices

Dietary Supplements

In addition to cinnamon and zinc mentioned earlier, vitamin D supplementation has shown promise. People with prediabetes who take vitamin D supplements have about 15% lower risk of developing diabetes (37).

Important Considerations

Before starting any supplements or alternative treatments:

  • Talk to your healthcare provider
  • Remember that supplements can interact with medications
  • Continue with proven treatments like diet and exercise
  • Choose reputable brands if you use supplements

Screening Recommendations

Early detection of prediabetes is important because treatment can prevent diabetes.

Who Should Be Screened?

The U.S. Preventive Services Task Force recommends screening for prediabetes and diabetes in:

  • Adults aged 35-70 years who are overweight or obese
  • Anyone with risk factors like family history, regardless of age

Screening should be repeated every 3 years if results are normal (40).

Screening in Children

Children and teens who are overweight and have additional risk factors should also be screened. Risk factors include:

  • Family history of type 2 diabetes
  • Being from certain ethnic groups
  • Signs of insulin resistance like acanthosis nigricans (dark patches of skin)

Testing should start at age 10 or at the start of puberty, whichever comes first (41).

Special Populations

Some groups have unique considerations when it comes to prediabetes.

Women with Polycystic Ovary Syndrome (PCOS)

Women with PCOS have higher rates of prediabetes and diabetes. They often have insulin resistance as part of their condition. Metformin is commonly used in women with PCOS to help with both metabolic and reproductive symptoms (25).

People Who Had Gestational Diabetes

Women who had diabetes during pregnancy have a much higher risk of developing type 2 diabetes later. About 20% develop diabetes within 10 years after pregnancy (42).

These women should be screened for diabetes 6-12 weeks after delivery and then regularly thereafter.

Older Adults

Prediabetes is very common in older adults. However, the benefits of intensive treatment need to be balanced with other health concerns. Some older adults may not live long enough to benefit from aggressive diabetes prevention (43).

Living with Prediabetes

Being diagnosed with prediabetes can feel overwhelming, but it’s also an opportunity to improve your health.

Making Sustainable Changes

The key to success is making changes you can maintain long-term. Small, gradual changes often work better than drastic ones. For example:

  • Start with 10-minute walks and gradually increase
  • Replace one sugary drink per day with water
  • Add one extra serving of vegetables to your meals

Practical Prevention Tips

Here are specific actions you can take to prevent diabetes:

For Weight Loss:

  • Aim to lose 5-7% of your body weight if you’re overweight
  • Use smaller plates to control portions
  • Fill half your plate with non-starchy vegetables
  • Keep a food diary to track what you eat

For Physical Activity:

  • Aim for at least 150 minutes of moderate activity per week
  • Break it up into 30 minutes, 5 days a week
  • Include both aerobic exercise (like brisk walking) and strength training
  • Take the stairs instead of elevators
  • Park farther away to walk more

For Better Sleep:

  • Aim for 7-8 hours of sleep per night
  • Keep a regular sleep schedule
  • Avoid screens before bedtime
  • Create a dark, cool sleeping environment

For Stress Management:

  • Practice relaxation techniques daily
  • Take regular breaks during work
  • Connect with friends and family
  • Consider counseling if stress is overwhelming

Getting Support

Many communities offer diabetes prevention programs. These programs provide education and support for making lifestyle changes. The National Diabetes Prevention Program has shown that structured support helps people achieve better results (44).

Digital Tools

Technology can help with diabetes prevention. Studies show that online programs and mobile apps can be effective for weight loss and improving blood sugar control (45).

The Importance of Early Action

Taking action when you have prediabetes is crucial. Early intervention not only prevents diabetes but also reduces your risk of:

  • Heart attacks and strokes
  • Kidney disease
  • Vision problems
  • Nerve damage

Studies show that people who participate in diabetes prevention programs have lower death rates and fewer cardiovascular events even 10 years later (9).

Monitoring Your Progress

If you have prediabetes, regular monitoring is important. Your doctor will likely recommend:

  • Blood sugar testing at least once a year
  • Regular blood pressure checks
  • Cholesterol testing
  • Weight monitoring

Some people see improvements in just a few months, while others take longer. The important thing is to keep working toward your goals.

When Prediabetes Progresses

Despite best efforts, some people with prediabetes will develop type 2 diabetes. This doesn’t mean you’ve failed. Many factors influence diabetes risk, including genetics.

If you do develop diabetes, the healthy habits you’ve developed will still help you manage the condition better. People who were physically active before developing diabetes often have better blood sugar control and fewer complications.

Future Directions

Research continues to improve our understanding of prediabetes. Scientists are working on:

  • Better ways to predict who will develop diabetes
  • New medications to prevent diabetes
  • Personalized prevention strategies based on genetics
  • Better understanding of how sleep and stress affect blood sugar

Advanced Testing

Researchers are studying new ways to identify people at high risk for diabetes. Metabolomic testing looks at small molecules in your blood to create a “fingerprint” of your metabolism. Studies show certain amino acids and lipids in the blood can predict diabetes risk years before it develops (46).

People with different subtypes of prediabetes have different metabolic profiles. Understanding these differences may lead to more personalized treatments (47).

Frequently Asked Questions

Can prediabetes be reversed?

Yes, prediabetes can often be reversed with lifestyle changes. Studies show that 33-59% of people with prediabetes can return to normal blood sugar levels within 1-5 years with proper treatment (11).

How often should I be tested if I have prediabetes?

If you have prediabetes, your doctor will typically check your blood sugar levels at least once a year. Some people may need more frequent testing depending on their risk factors.

What’s the best diet for prediabetes?

There’s no single “best” diet, but research supports several approaches including the Mediterranean diet, DASH diet, and moderate carbohydrate restriction. The most important factors are eating more vegetables, whole grains, and lean proteins while limiting processed foods and sugary drinks.

Do I need medication if I have prediabetes?

Not everyone with prediabetes needs medication. Lifestyle changes are the first-line treatment. Your doctor may recommend medication like metformin if you’re at very high risk, such as having a BMI over 35, being under 60 years old, or having a history of gestational diabetes.

Can children get prediabetes?

Yes, children can develop prediabetes. About 18% of adolescents in the United States have prediabetes. Children who are overweight and have other risk factors should be screened starting at age 10 or at puberty.

Conclusion

Prediabetes affects millions of people, but it doesn’t have to lead to diabetes. Through lifestyle changes like weight loss, healthy eating, and regular physical activity, many people can bring their blood sugar back to normal levels.

The key is to take action early. Even small changes can make a big difference in your health. If you think you might have prediabetes, talk to your healthcare provider about getting tested. With the right approach, you can prevent or delay type 2 diabetes and improve your overall health.

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